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Age_Coonfield
-"`R- w APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR '` PROPERTY TAX BENEFITS \ '�. -': �! State Form 43708(R16/1-23) A/� ^7 + Prescribed by the Department of Local Government Finance yQ\1 4 Fw� `O Dy Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. INSTRUCTIONS: To be filed in person or by mall with the county auditor of the county where the property is located. Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by t allowing January 5 of the calendar year in which the property taxes are first due and payable. ---reverse si.e additional instructions and qualifications. 1 4 I Type.f questsd(Please check all that apply) ✓� '4)1 C�Over 65 Deduction from Assessed Valuation L Owned with Joint Tenant6(4Fp at ommon,Indicat with Wh hd'Yes ❑ No .906 >>' • If Name on Record Is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Com T't eside on the Property? ❑ Yes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under R rded Contract for at Least k ' ( .• One(1)Year before Claiming Deduction? Yes ❑ No Address of Contract Seller(number and street,city,state,and ZIP code) the operty in Question: eat Property El Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number C:01 Vitt JP 1 Q a u--(Lk --19--Q0 14 - O©O . z,1 9f- ODu Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or $199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[al ®�es ❑ No Indiana real property]for the io EKes El ,W_ No �..A'(1t du,.�.2 0—^I . ‘\ Have You Filed for Deduction in Any Other County? If Yes,What County? Ea yes 14 No 7 '0/7 d j �� 0t0I"7,. '_ `f d I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature:of-Applicant .,.-2:-.. ) Date(month,day,year) J tAddress of Applicant(number and street,city,state,an ZIP code)�lCi Ut S . 12►-aS E. Q 4.a�t.�l . • LA-1l Q . Signature of Authorized Representative ` Date(month,day,year) Address of Authorized Representative(number and street,city,stale,and ZIP code) Signature of County Auditor Date(month,day,year) a Q o a . �� A-u�:.�...t/ mom. -1 -Z.z- zLi . -1-72-zy, .) .0..Q.k&. ,W c_t_s_„4„.„4.:„..._,,,,_/s).0.--,nr-, ekr---t-i. <----4 DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer 4- ibAk-t- ,(..)-4-(13\ANI,S._al Mi'-'L Gk. rn 7 -